Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for A4490. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export and state network lists
- Email alerts when a state changes its rates
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Publishing states
23
Median % of Medicare
--
Rate range
$0.01 - $85.61
A4490 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $9.95 | -- | -- | 2026 |
| Colorado | $7.22 | -- | -- | 2026 |
| Delaware | $60.00 | -- | -- | 2026 |
| Hawaii | $11.44 | -- | -- | 2025 |
| Iowa | $7.50 | -- | -- | 2024 |
| Idaho | $7.94 | -- | Not required | 2025 |
| Indiana | $58.14 | -- | -- | 2026 |
| Kansas | $25.00 | -- | -- | 2009 |
| Louisiana | $45.91 | -- | -- | 2026 |
| Maine | $7.21 | -- | -- | 2026 |
| Michigan | $5.40 | -- | -- | 2026 |
| Missouri | $0.01 | -- | Not required | 2003 |
| North Carolina | $14.78 | -- | -- | 2025 |
| Nebraska | $19.67 | -- | -- | 2026 |
| New Hampshire | $85.04 | -- | Not required | 2026 |
| Nevada | $6.23 | -- | -- | 2024 |
| Ohio | $25.00 | -- | -- | 2006 |
| Texas | $17.80* | -- | -- | 2011 |
| Utah | $17.25* | -- | Not required | 2010 |
| Virginia | $15.25 | -- | -- | 2010 |
| Vermont | $85.61 | -- | -- | 2026 |
| West Virginia | $29.70 | -- | -- | 2026 |
| Wyoming | $18.53 | -- | -- | 2021 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related dme & supplies codes
- A2001 - Innovamatrix ac, per square centimeter (add-on, list separately in addition to primary procedure)
- A2002 - Mirragen advanced wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2005 - Microlyte matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2006 - Novosorb synpath dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2007 - Restrata, per square centimeter (add-on, list separately in addition to primary procedure)
- A2008 - Theragenesis, per square centimeter (add-on, list separately in addition to primary procedure)
- A2009 - Symphony, per square centimeter (add-on, list separately in addition to primary procedure)
- A2010 - Apis, per square centimeter (add-on, list separately in addition to primary procedure)
All 238 codes from A4206 to A4932 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for A4490?
23 state Medicaid programs publish a fee-for-service rate for A4490 (surgical stockings above knee length, each), ranging from $0.01 in Missouri to $85.61 in Vermont. The full table on this page lists every publishing state's current rate.
Which state pays the most for A4490?
Vermont publishes the highest Medicaid rate for A4490 at $85.61. Missouri publishes the lowest at $0.01.
Does A4490 require prior authorization under Medicaid?
No publishing state flags A4490 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.